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Blog: Poverty Alone Does Not Mean Abuse

Posted on September 19, 2022

Blog-headline

Posted 9/19/2022

ACNJ Legal Intern Esther Thomas

By Esther Thomas,
ACNJ Legal Intern, Summer '22

Over the past several years, those working on child abuse and neglect cases have raised public awareness concerning the overrepresentation of children of color involved with child protective services. This is not just an issue in New Jersey - it is a topic of national conversation. Looking at data compiled by the New Jersey Department of Children and Families, 84,162 reports of alleged child abuse or neglect were made in 2021, while only 3,008 of those reports came back with substantiated findings. This shows that only 3.57% of the reports made were actual cases of neglect or abuse. As seen by the graph below, out of the substantiated findings in 2021, Black and Hispanic children are represented at a rate 2-3 times higher than other groups. In New Jersey, almost all of these children and youth come from impoverished homes. This raises the question of whether the New Jersey Division of Child Protection and Permanency (DCPP) should be involved with these children, or if further scrutiny is required to avoid unwarranted state involvement. 

New Jersey Child Maltreatment Rate 2014-2021

There could be many reasons for this overrepresentation, one being the result of excessive state supervision and more interaction through state poverty programs in poorer neighborhoods. Families who need to use social welfare programs normally have more supervision or interaction with the state in their day-to-day life. This phenomenon is referred to as the visibility hypothesis, which describes a disproportionate number of underprivileged children to privileged children within the child welfare system because poverty makes children more noticeable to child welfare authorities. Furthermore, there seems to be ignorance and intolerance of the “conditions of social and economic disadvantage in urban neighborhoods [that] leads to overvisibility.” The visibility hypothesis explains how the easily seen attributes of poverty combined with prejudice and lack of sympathy for these situations lead to families who need governmental assistance also being the families child protective services involve themselves with the most.

People who normally report to child services are laypersons who may see a situation and think it is neglect when, in actuality, it is just an incidence of poverty. Evidence shows that laypersons who have a lower socioeconomic background are less likely to report impoverished situations as neglect. This shows a lack of understanding from people of higher socioeconomic backgrounds to the difficulties that are presented in the daily lives of people who live in poverty. This misunderstanding leads to two types of misreporting: (1) underreporting actual instances of neglect, and (2) overreporting or incorrectly claiming neglect. These reports open the door for state involvement in a family’s life, which may lead to direct involvement from child protective services. 

Traditional services applied by child welfare services may be ineffective when trying to remedy situations of poverty that appear to be child neglect. In most definitions, neglect is found if a child does not have all their basic needs met and could be harmed from their needs not being met. Under many definitions of neglect, poverty can be equated to neglect unless otherwise specified. If child welfare services become involved for all the reasons discussed above, then the determination made is based on a definition that automatically makes people who are living in poverty more susceptible to a finding of neglect. However, on top of that, public resources put in place to alleviate poverty are insufficient to actually relieve poverty, and there has been a growing trend to restrict aid when the need is increasing. There are also incidents of poverty that could lead to a situation that looks like neglect. For example, poorer parents may suffer from social isolation because there are fewer adults in their lives who can help out and provide support.

While there is not a clear answer to how this problem should be resolved, there have been a couple of suggestions. One proposal advocates for changing how child protective services interact with families. Instead of making the process an adversarial investigation, child welfare should come in non-adversarially and develop mutually agreed-upon solutions. An additional proposal recommends providing families social support that allows them a place to go for help before child proactive services become involved. Another way to efficiently use child welfare resources is to do blind removal decisions, where child protective service professionals make a decision based on an initial assessment of a case without certain demographics like race or the neighborhood where the family lives. This system was tested in Nassau County in New York. In 2010, 55.5% of the children removed from homes were Black. In five years, after using blind removals, this went down to 29%. Removing unnecessary information regarding socioeconomic factors may reduce the number of families in poverty involved with child protective services where there is no issue of neglect. While there is not a clear set of alternative measures that could be used to replace the current system in place, there is a definite need for a system that stops targeting families in poverty.

It is also important to look at how New Jersey courts determine what actions constitute neglect, and how the courts’ definition affects situations where poverty is a factor. N.J.S.A. § 9:6-8.21 defines neglect as:

“a . . . failure of [a] parent or guardian, as herein defined, to exercise a minimum degree of care (a) in supplying the child with adequate food, clothing, shelter, education, medical or surgical care though financially able to do so or though offered financial or other reasonable means to do so, or (b) in providing the child with proper supervision or guardianship, by unreasonably inflicting or allowing to be inflicted harm, or substantial risk thereof, including the infliction of excessive corporal punishment; or by any other acts of a similarly serious nature requiring the aid of the court.”

New Jersey courts have focused specifically on the phrase “minimum degree of care” to determine whether the parent or guardian’s action constitutes child neglect. Per the New Jersey Supreme Court, “minimum degree of care” means grossly negligent conduct. This conduct does not need to be intentional but can be anything from slight oversight to malicious purpose to cause injury. The Court provided a definition to determine the “minimum degree of care” because it was determined that it was more important to look at the actual harm that occurred to the child rather than the intent behind the guardian’s action. The Court also decided that this inquiry would be made on a case-by-case basis depending on the dangers of the given situation and whether the caregiver in the situation acted appropriately.

In 2011, the New Jersey Supreme Court held that a case of ordinary negligence is not enough to constitute child neglect. They described the attitude needed to find neglect as a reasonable person realizing the risks and acting with reckless disregard for others’ safety. The Court stated “[e]ven watchful parents find it a near impossibility to be aware of a child’s movements at every turn,” making a point that a single harmless accident does not constitute neglect. In making these decisions, the Court determined that the legislative intent behind N.J.S.A. § 9:6-8.21 was to protect children from unsafe situations rather than punish parents for a harmless accident. The Court made it clear that to be found guilty of child neglect or endangerment, a parent or guardian must willfully act in a way that is likely to result in an injury. The court decided on a lower standard than simple negligence because if simple negligence was considered neglect, then a normal accident could be considered neglect. This could have significant consequences on family life. Situations in which children are not being harmed and living healthy, happy and safe lives will be intruded upon by members of child protective services. 

New Jersey courts have regularly decided that while poverty can be used as one factor in deciding whether a child is being neglected, poverty alone cannot constitute neglect. This is illustrated in a case where a mother brought her children to the Division looking for aid and was fully willing to cooperate with the Division’s recommendations because she did not have housing. The mother had already tried to secure a job, welfare and housing, but was unsuccessful mostly due to child care issues. The Division noted that the children seemed healthy and safe. Despite this, the family court judge said the family’s homelessness was due to the mother’s poor planning for coming to the state with insufficient funds to travel home, and ruled for neglect. The Appellate Division reversed this ruling, stating that the mother’s poor planning was “at least in part a side-effect of poverty.” However, she sought help from the resources available to her to do what was best for her children. The Court also emphasized the importance that impoverished and homeless parents feel like they can use resources meant to help without fear of being punished for “poor planning.”

While poverty alone cannot cause a finding of neglect, poverty alone can be a reason why state actors get involved with a family. This involvement can lead to many complications. One complication is that children can be separated from their families, only for a later appeal to make it clear that the original decision and separation were made wrongfully. Furthermore, when looking at poverty, the minimum degree of care standard of gross or wanton negligence is still in effect. Courts consider poverty as one of many factors that will be weighed to determine whether neglect actually exists, but poverty alone is not a basis for a finding of abuse or neglect.

Child Poverty Rates Decreasing, Per Recent Census Data

Posted on September 19, 2022

Blog-headline

Posted 9/19/2022

headshot Alena

By Alena Siddiqui,
Kids Count Coordinator

Childhood poverty rates in the United States have decreased 59% since 1993, according to the newly released report by Child Trends and Columbia University, Lessons From a Historic Decline in Child Poverty. The report focuses on the Census Bureau's Supplemental Poverty Measure, a measure that includes government benefits such Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and the Earned Income Tax Credit (EITC), sometimes called the “social safety net”, to determine overall income. The American Community Survey's poverty data, which is the official source, do not include these benefits, instead focusing on cash income.

Including government benefits when calculating the Supplemental Poverty Measure provides a more well-rounded picture of the state of poverty for families and how these social safety net programs assist poor and low-income communities. As of 2021, 17,301 New Jersey children lived in families receiving TANF, and 393,310 received SNAP benefits. In 2018, 59,490 families claimed EITC. Data showing the number of people and households enrolled in SNAP, TANF and EITC are available through ACNJ's data dashboard. Per the SPM numbers, the Child Tax Credit and the Earned Income Tax Credits significantly contributed to the decline in child poverty in 2021. However, New Jersey saw a decline in families relying on these social service safety nets, such as EITC. See the recent blog concerning the decrease in the number of NJ families claiming EITC credits

The number of uninsured children has decreased as well. New American Community Survey data show that New Jersey had 75,765 children under 19 without health insurance in 2021, or 3.5% of the child population. This is a 14% decrease from 2019 and a 3.1% decrease from 2017. The number of children under 19 enrolled in NJ FamilyCare in 2021 reached 851,417, a 5.3% increase from 2017 and an 8.8% increase from 2019.

Overall, the Supplemental Poverty Measure data illustrate an encouraging trend of how programs in the social safety net can benefit children. More work is needed to simplify enrollment processes to allow all eligible families to enroll in the future.

Safe Babies Court Team Approach is Working in NJ: Time to Expand

Posted on September 16, 2022

Blog-headline

Posted 9/16/2022

Mary Coogan, Esq.,
ACNJ Vice President

By Mary Coogan,
ACNJ Vice President

The hard work and commitment of those involved in New Jersey's child welfare system including Division of Child Protection and Permanency (CP&P) staff, department leadership, attorneys, caretakers, service providers, judges, court staff and court volunteers has resulted in a steady and significant reduction in the number of children and youth living in foster care. Currently, that number is approximately 3,200, which is terrific news. Stakeholders continue to work collaboratively to implement best practices that can further reduce the need for children to have to be removed at all and support and strengthen families.

Unfortunately, 35% of children living in foster care are aged five and under - a critical time for development. National advocacy nonprofit ZERO TO THREE, in response, developed Safe Babies Court Team Approach (SBCT), a set of best practices specifically focused on the developmental needs of infants and toddlers and their families who are involved in child welfare cases. These best practices can help reduce the number of babies living in foster care, using the science of early child development as a basis for decision-making, connecting families to relevant concrete community supports and services focused on early childhood development and the well-being of both parents and children. The goal is to advance the health and well-being of infants and toddlers living in foster care and those at risk of being removed from their parents because of abuse or neglect so that they can flourish.

Partnering with CP&P and the New Jersey courts, CASA of Passaic County brought the Safe Babies Court Team Approach to New Jersey, piloting the program in Passaic, Essex and Hudson counties. A county leadership team established case eligibility criteria and meets regularly to engage in collaborative and proactive problem-solving. The assigned Family Court Judge, who is a member of the county team, reviews the SBCT cases more often than other cases to ensure that progress is being made. Parents must agree to have their case assigned to the SBCT. Initial data show promise, and the cases applying the SBCT Approach have babies successfully returning home to stronger and more stable parents.

The goal of the SBCT Approach is for children to maintain healthy development and have lasting permanency, specifically family reunification whenever safely possible. The baby is at the center of all decision-making. Sustained cooperation of the numerous professionals involved in the case, the parents and the family the infant or toddler is placed with, often a relative or close family friend, is critical to the program’s success.  

There is a community coordinator, an individual previously involved in some aspect of the child welfare system, such as a person with “lived experience”, who engages and works with the family to help them identify and access needed services to strengthen their family. These coordinators work to find local services for the parents and to meet the developmental needs of infants and toddlers. An analysis of the jurisdictions using the ZERO TO THREE SBCT Approach demonstrated that 83.7% of the children with closed cases were in a permanent home within 12 months, far exceeding the national Children’s Bureau standard of 40.5%. The infants and toddlers involved with SBCT had fewer placements, and 48.6% of them were successfully reunified with their parents; 14% were placed with a fit and willing relative and 32.2% were adopted. Moreover, SBCT-involved infants and toddlers were more likely to receive developmental screens, and needed less early intervention services and oral health care than their peers. Parents also received needed health care and treatment in a more timely manner. 

The Turrell Fund is providing support for these pilots, bringing together a statewide advisory group of providers and experts to troubleshoot implementation issues and identify community providers who can help strengthen families. The pilot programs were made possible with the generous support of ZERO to THREE. 

Given the success to date, it is time to expand the Safe Babies Court Team Approach to other counties.

For more information, contact Mary Coogan at mcoogan@acnj.org

Urge Congress to support home visiting services by reauthorizing MIECHV by Oct. 1

Posted on September 9, 2022

The Maternal Infant and Early Childhood Home Visiting (MIECHV) Program, the primary source of funding for New Jersey’s robust home visiting system, is set to expire. If MIECHV is not reauthorized by October 1, more than 5,000 NJ families annually could lose effective home visiting services that improve children's health, school readiness and economic security. Send a message to your Members of Congress now. 

Advocacy efforts have led to the introduction of The Jackie Walorski Maternal and Child Home Visiting Act of 2022 (HR 8876). Click here to send a message to your Member of Congress to support/co-sponsor this legislation.

Telemedicine: An Opportunity to Address the Current Health Needs Among Youth

Posted on September 6, 2022

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Posted 9/6/2022

headshot-alana-vega

By Alana Vega
ACNJ Health Policy Analyst and Youth Engagement Coordinator

Since the onset of the COVID-19 pandemic, the usage of healthcare delivered through video conferencing systems or telephone, also known as telemedicine or telehealth, has increased. Thanks to recent state legislation, New Jersey families -- including those on publicly funded health insurance such as Medicaid and CHIP -- may have telemedicine services reimbursed by private insurers and NJ FamilyCare. Previously, New Jersey permitted limited access to these sorts of services, particularly for those enrolled in Medicaid. For some, telemedicine may seem strange because of its unfamiliarity. Yet, practices across the country have long relied on telemedicine, particularly in rural areas. 

Physical and Mental Health Services

Telemedicine services can be administered in a myriad of ways. For many, client/provider interactions over video conference systems like Zoom, Webex, and FaceTime likely come to mind. However, providers have reported success administering healthcare over traditional audio-only telephone calls. This practice is especially important when connecting with rural populations, older Americans and those without a reliable internet connection.

Internet Access and Telehealth Care

Households_With_Smartphones_Cellphones_Primary_Device_Internet_Access_Point_2020_5yr_Est

Although telehealth may be a means of increasing access to healthcare across the Garden State, concerns regarding internet and device access remain persistent. The “digital divide” is a term used to refer to the gap between those with internet and computer access and those without. In New Jersey, and across the country, data show that many households do have some type of internet access. According to the Pew Research Center, 93% of U.S. adults reported using the internet in 2021, compared to 76% in 2010. Data from the same set indicate that 15% of adults are smartphone-dependent--meaning they rely on their smartphones as their primary source of internet connection and do not have broadband internet at home.

Pre-pandemic, the majority of telemedicine visits were for urgent care needs; however, primary care visits, management of chronic conditions and specialist visits all saw an increase in telemedicine utilization post-2020. Physicians reported satisfaction with telemedical services--with more than 70% indicating a willingness to use technology for visits encompassing prescription renewals, chronic care management and/or post-surgical check-ins. 

It is important to note that telehealth is not meant to replace in-person services entirely, but rather bolster the existing number of options offered to families. Some studies indicate patients were less satisfied with telehealth services. While not specific to children, one study demonstrated concerns among older, chronically-ill patients of color, who expressed difficulty building trust with their physician through a virtual visit. Another study points to a higher rate of antibiotic prescriptions than in-person care among children who attended virtual visits for respiratory infections. Unnecessary prescription of antibiotics has been cited by the Centers for Disease Control (CDC) as a factor contributing to antibiotic resistance, which could have a significant impact on the medical community’s ability to fight infections. There is also evidence showing that telehealth visits generate new concerns such as finding a quiet, solitary space for teletherapy visits to address mental health, protecting patient’s health information shared through telemedicine visits, and addressing gaps in familiarity with technology among patients and providers.

Despite some of the challenges associated with telemedical services, those specifically addressing mental health appear to have more widespread success--both from the patient and provider perspective. According to a Trilliant Health analysis of telehealth utilization between April 2019 and November 2021, behavioral health visits accounted for the single largest share of telehealth visits.

In their declaration of a national mental health emergency for children and teens, the American Academy of Pediatrics (AAP), the Children’s Hospital Association (CHA) and the American Academy of Child and Adolescent Psychiatry (AACAP) call for a variety of interventions and policy solutions to address the needs of young people. Among the list is a need to “address the regulatory challenges and improve access to technology to assure continued availability of telemedicine to provide mental health care to all populations.” A number of sources indicate that telemedicine can complement more traditional forms of mental health services or to provide specialized care for young people with specific needs.

In 2018, the New Jersey Pediatric Mental Health Care Access Program, managed by the New Jersey Chapter, American Academy of Pediatrics (NJAAP), utilized telepsychiatry to administer services to children in hubs across the state. Initially, a handful of the programs used video conferencing to see patients; as of April 2020, all nine hubs in the state leaned on telehealth services to reach their clients. Although some barriers were identified--limited office space for telepsychiatry visits as well as spotty or no internet access among patients--both providers and patients reported satisfaction with a number of features within the program. Telepsychiatry for children and adolescents, based on the experiences within the program, pointed to easier access to services through a reduction in transportation and scheduling barriers and more timely and appropriate referrals. 

Among older youth ages 15-26, also known as “transition age youth”, telemental health is seen as an opportunity to bridge the gap in services offered to those transitioning from high school or college to career. Mental health services for this age group are in high demand, as many young people leave pediatric practices and begin to navigate the adult healthcare system on their own. 

Conclusion

These findings for behavioral health services delivered through virtual systems come at a crucial time. In the final months of 2021, several authorities, including the CDC, AAP, CHA and AACAP, sounded the alarm for adolescent mental healthcare. The 2022 National KIDS COUNT Data Book points to a 40% increase in New Jersey children ages 3-17 with anxiety or depression, jumping from 7.6% of children in 2016 to 10.7%. More recent 2021 data, released by the Centers for Disease Control, show how the COVID-19 pandemic impacted high school students, with more than a third of those surveyed indicating poor mental health during the pandemic. As we enter a new school year--the second in-person instruction year since the pandemic began--assessing new methods of mental health service delivery to adolescents and young adults will be imperative.